Ch. 26 Cardiac

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? a. Atrial flutter b. Atril fibrillation c. Ventricular fibrillation d. Ventricular tachycardia

A. Atrial flutter

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following? a. Atrial rate of 300 to 400 b. Normal PR interval c. Regular rhythm d. P wave resent before each QRS

a. Atrial rate of 300 to 400

A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching? a. "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." b. "I will document the date and time if my ICD fires." c. "I can play golf with my son in about 2 or 3 weeks." d. "I should tell close friends and family members that I have an ICD."

a. "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD."

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? a. "I should ask for a handheld device search when I go through airport security." b. "I should avoid large magnetic fields, such as an MRI machine or large motors." c. "I should avoid contact sports." d. "I'll watch the incision for swelling or redness and will report if either occurs."

a. "I should ask for a handheld device search when I go through airport security."

The nurse receives a telephone call from a client with an implanted pacemaker who reports that his pulse is 68 beats per minute, but his pacemaker rate is set at 72 beats per minute. The best response by the nurse is which of the following? a. "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." b. "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate." c. "This is okay as long as you are not having any symptoms." d. "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase."

a. "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."

Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds? a. 0.2 b. 0.1 c. 0.3 d. 0.4

a. 0.2

The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record? a. Bigeminy b. Couplets c. Multifocal PVCs d. R-on-T phenomenon

a. Bigeminy

You are taking a pre-nursing pharmacology class. Today you are learning about anti-dysrhythmic drugs. What drug is a potassium channel blocker? a. Cordarone b. Lidacaine c. Tambocor d. Isoprel

a. Cordarone

Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke? a. Coumadin b. Aspirin c. Lovenox d. Plavix

a. Coumadin

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? a. Elective electrical cardioversion b. Chemical cardioversion c. Mace procedure d. Elective electrical defibrillation

a. Elective electrical cardioversion

The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a. Fluttering b. Nausea c. Hypotension d. Fever

a. Fluttering

A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes? a. Implantable cardioverter defibrillator b. Pacemake c. Atropine d. Epinephrine

a. Implantable cardioverter defibrillator

The nurse is aware that parasympathetic stimulation and certain medications can cause first-degree AV block. Choose the medication that should be evaluated. a. Inderal b. Coumadin c. Indocin d. Celebrex

a. Inderal

Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? a. Keep the arm on the side of the pacemaker higher than the head b. Delay activities such as swimming and bowling for at least 3 weeks c. Keep moving the arm on the side where the pacemaker is inserted d. Avoid sources of electrical interference

a. Keep the arm on the side of the pacemaker higher than the head

Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block? a. PR interval b. QRS c. T wave d. P wave

a. PR interval

A healthy 46-year-old woman is seeing her health care provider for her annual physical examination. While the nurse is taking the patient's vital signs, the patient states, "Occasionally, my heart skips a beat. Is this normal?" The nurse explains that this feeling is caused by which of the following? a. Premature atrial complex b. Atrial flutter c. Sinus tachycardia d. Ventricular fibrillation

a. Premature atrial complex

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? a. Premature ventricular contraction (PVC) b. Ventricular bigeminy c. Ventricular tachycardia d. Ventricular fibrillation

a. Premature ventricular contraction (PVC)

A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next? a. Question the client about alcohol and illicit drug use. b. Instruct the client to hold the breath and bear down. c. Prepare to administer a calcium channel blocker. d. Place the client on supplemental oxygen.

a. Question the client about alcohol and illicit drug use.

The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? a. Right side of sternum, fourth intercostal space b. Left side of sternum, fourth intercostal space c. Midway between V2 and V4 d. Mid-clavicular line, fifth intercostal space

a. Right side of sternum, fourth intercostal space

You are discussing complications of a pacemaker with a group of nursing students. One of the students asks about complications associated with use of a cardiac pacemaker. Which of the following items are considered complications of a pacemaker? Choose all that apply. a. Twiddler syndrome b. Hiccuping c. Positive Kernig's d. Local infection e. Negative Babinski

a. Twiddler syndrome b. Hiccuping d. Local infection

Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low? a. U wave b. T wave c. P wave d. QT interval

a. U wave

a patient has had an implantable cardioverter defibrillator inserted. what should the nurse be sure to include in the education of this patient prior to discharge? a. avoid magnetic fields such as detection booths b. call for emergency assistance if feeling dizzy c. record events that trigger a shock sensation d. the patient may have a throbbing pain that is normal e. the patient will have to schedule monthly chest xrays to make sure the devise is patent

a. avoid magnetic fields such as detection booths b. call for emergency assistance if feeling dizzy c. record events that trigger a shock sensation

the nurse in the ICU hears an alarm sound in the patient's room. arriving in the room the patient is unresponsive, without a pulse, and a flat line on the monitor. what is the first action by the nurse? a. begin CPR b. administer epinephrine c. administer atropine 0.5mg d. defibrillate within 360 joules

a. begin CPR

a patient with dilated cardiomyopathy is having episodes of vfib. what choice would be best to sense and terminate these episodes? a. implantable cardioverter defibrillator b. pacemaker c. atropine d. epinephrine

a. implantable cardioverter defibrillator

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment? a. A suction machine b. A defibrillator c. Cardioversion equipment d. An ECG machine

b. A defibrillator

A client's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as a. Atrial fibrillation b. Atrial flutter c. Ventricular fibrillation d. Ventricular tachycardia

b. Atrial flutter

After taking an ECG on a 38-year-old woman, the nurse reports that the PR interval reflects normal sinus rhythm. The nurse has made this interpretation based on the PR interval of: a. 0.05 and 0.1 seconds. b. 0.12 and 0.2 seconds. c. 0.15 and 0.3 seconds. d. 0.25 and 0.4 seconds.

b. 0.12 and 0.2 seconds.

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? a. PP interval b. QT interval c. RR interval d. TP interval

c. RR interval

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? a. Fracture of the lead wire b. Lead wire dislodgement c. Faulty generator d. Sensitivity is too low

b. Lead wire dislodgement

Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? a. P wave b. QRS complex c. PR interval d. QT interval

b. QRS complex

The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up? a. PR interval that is 0.18 seconds long b. QT interval that is 0. 46 seconds long c. QRS complex that is 0.10 seconds long d. ST segment that is isoelectric in appearance

b. QT interval that is 0. 46 seconds long

the nurse is monitoring a patient in the PACU following a coronary artery bypass graft, observing a regular ventricular rate of 82bpm and "saw-tooth" P waves with an atrial rate of approximately 300bpm. how does the nurse interpret this rhythm? a. atrial fibrillation b. atrial flutter c. ventricular tachycardia d. ventricular fibrillation

b. atrial flutter

When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be: a. triggered. b. captured. c. inhibited. d. nonsynchronous.

b. captured.

a patient is 2 days post-op after having a permanent pacemaker inserted. the nurse observes that the patient is having continuous hiccups as the patient states, "i thought this was normal". what does the nurse understand is occurring with this patient? a. fracture of the lead wire b. lead wire dislodgement c. faulty generator d. sensitivity is too low

b. lead wire dislodgement

the nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. what should the nurse examine to determine this part of the analysis? a. PP interval b. QT interval c. RR interval d. TP interval

c. RR interval

The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? a. It is a scheduled procedure 1 to 10 days in advance. b. The client is sedated before the procedure. c. It is used to eliminate ventricular dysrhythmias. d. It uses less electrical energy than cardioversion.

c. It is used to eliminate ventricular dysrhythmias.

a patient diagnosed with HTN has a newly diagnosed afib. what medication does the nurse anticipate administering to prevent the complication of atrial thrombi? a. Adenosine b. Amiodarone c. Warfarin d. Atropine

c. Warfarin

Which is not a likely origination point for cardiac dysrhythmias? a. atria b. ventricles c. bundle of His d. atrioventricular node

c. bundle of His

a patient has had several episodes of recurrant tachydysrhythmias over the last 5 months and medication therapy has not been effective. what procedure should the nurse prepare the patient for? a. insertion of an ICD b. insertion of a permanent pacemaker c. catheter ablation therapy d. maze procedure

c. catheter ablation therapy

The nursing instructor is discussing pacemakers with her clinical group. One of the students is caring for a client with a transvenous pacemaker. One of the students asks why this client has a transvenous pacemaker. What would be the instructor's best response? a. "A transvenous pacemaker is used in place of a transarterial pacemaker." b. "A transvenous pacemaker is a permanent pacemaker that is asynchronous." c. "A transvenous pacemaker is used for a ventricular tachyarrhythmia." d. "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."

d. "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."

the nurse is defibrillating a patient in vfib with paddles on a monophasic defibrillator. how much paddle pressure should the nurse apply when defibrillating? a. 5-10lbs b. 10-15lbs c. 15-20lbs d. 20-25lbs

d. 20-25lbs

A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as a. 80 bpm b. 70 bpm c. 100 bpm d. 90 bpm

d. 90 bpm

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? a. A new myocardial infarction client b. A client with poor kidney perfusion c. A client with third-degree heart block d. A client with atrial dysrhythmias

d. A client with atrial dysrhythmias

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients? a. Clients with recurrent life-threatening bradycardias b. Clients with sinus tachycardia c. Clients with ventricular bradycardia d. Clients with recurrent life-threatening tachydysrhythmias

d. Clients with recurrent life-threatening tachydysrhythmias

Cardioversion is used to terminate dysrhythmias. With cardioversion, the: a. Amount of voltage used should exceed 400 watts/second. b. Electrical impulse can be discharged during the T wave. c. Defibrillator should be set to deliver a shock during the QRS complex. d. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.

d. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.

The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? a. Defibrillation b. Maze procedure c. Pacemaker implantation d. Elective cardioversion

d. Elective cardioversion

You are caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? a. Defibrillation b. Mace procedure c. Pacemaker implantation d. Elective cardioversion

d. Elective cardioversion

A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? a. Ventricular tachycardia b. Atrial fibrillation c. Third-degree heart block d. Ventricular fibrillation

d. Ventricular fibrillation

the nurse is assessing vital signs in a patient with a permanent pacemaker. what should the nurse document about the pacemaker? a. date and time of insertion b. location of the generator c. model number d. pacer rate

d. pacer rate

a patient comes to the ED with complaints of chest pain after using cocaine. the nurse assess the patient and obtains vital signs with results as follows: BP 140/92, HR 128, RR 26, O2 sat 98%. what rhythm on the monitor does the nurse anticipate viewing? a. sinus bradycardia b. ventricular tachycardia c. normal sinus rhythm d. sinus tachycardia

d. sinus tachycardia

a patient who had a MI is experiencing severe chest pain and alerts the nurse. the nurse begins assessment but suddenly the patient becomes unresponsive, no pulse, with the monitoring showing a rapid, disorganized ventricular rhythm. what does the nurse interpret this rhythm to be? a. ventricular tachycardia b. atrial fibrillation c. third-degree heart block d. ventricular fibrillation

d. ventricle fibrillation